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Opportunities for Supporting Populations Impacted by Opioid
Misuse and Substance Use Disorders Mihn Le, Office of Child Care
Maria Pestalardo, Office of Child Care, Region VJeanne VanOrsdal and Ronna Schaffer, Infant/Toddler Specialists,
Child Care State Capacity Building Center
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Increase awareness of the opioid and substance misuse public health crisis
Review the Child Care and Development Fund (CCDF) information memorandum policy flexibilities
Explore policy-to-practice opportunities
Identify effective State and Territory Lead Agency strategies
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Session Objectives
Setting the stage Overview of information memorandum (IM) Child Care and
Development Fund (CCDF) Policy Opportunities for Supporting Populations Impacted by Opioid Misuse and Substance Use Disorders
Region V perspective State and Territory Lead Agencies: policy to practice Table conversation
Eligibility Funding, grants, and contracts Training and quality Consumer education Coordination of services
Wrapping it up
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Agenda
From 1999 to 2017, more than 700,000 people have died from a drug overdose.
Around 68 percent of the more than 70,200 drug overdose deaths in 2017 involved an opioid.
In 2017, the number of overdose deaths involving opioids (including prescription opioids and illegal opioids like heroin and illicitly manufactured fentanyl) was 6 times higher than in 1999.
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Setting the Stage
Excerpted from U.S. Centers for Disease Control and Prevention. (2018). Understanding the epidemic [Web page]. Retrieved June 18, 2019, from https://www.cdc.gov/drugoverdose/epidemic/index.html
Source: U.S. Department of Health and Human Services. (n.d.). What is the U.S. opioid epidemic? [Web page]. Retrieved July 23, 2019, from https://www.hhs.gov/opioids/about-the-epidemic/
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What We Know about the Opioid Crisis
Roughly 21 percent to 29 percent of
patients prescribed opioids for chronic pain misuse them.
Between 8 percent and 12 percent
develop an opioid use disorder.
Approximately 80 percent of people
who use heroin first misused prescription
opioids.
Source: National Institute on Drug Abuse, National Institutes of Health, U.S. Department of Health and Human Services. (2018). Opioid overdose crisis [Web page]. Retrieved April 11, 2018, from https://www.drugabuse.gov/drugs-abuse/opioids/opioid-overdose-crisis
Source: National Institute on Drug Abuse, National Institutes of Health, U.S. Department of Health and Human Services. (2019). Opioid summaries by state [Web page]. Retrieved July 23, 2019, from https://www.drugabuse.gov/drugs-abuse/opioids/opioid-summaries-by-state
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Opioid-Related Overdose Death Rates
National Opioid Misuse Community Assessment tool from NORC at the University of Chicago https://opioidmisusetool.norc
.org/
Opioid Summaries from the National Institute on Drug Abuse https://www.drugabuse.gov
/drugs-abuse/opioids/opioid-summaries-by-state
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Information at the State and County Levels
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Neonatal Abstinence Syndrome (NAS)
Neonatal abstinence syndrome (NAS) is a group of conditions that an infant experiences when withdrawing from exposure to substance.
The number of babies born in the U.S. with a drug withdrawal symptom increased 383% during 2000-2012.
The severity of signs and symptoms are impacted by multiple factors.
Excerpted from: Centers for Disease Control and Prevention, Morbidity and Mortality Weekly Report, Incidence of Neonatal Abstinence Syndrome, [Web page]. Retrieved July 25, 2019, from https://www.cdc.gov/mmwr/volumes/65/wr/mm6531a2.htm. Source: National Institute on Drug Abuse, New Studies Clarify Risk Factors for Neonatal Abstinence Syndrome. Retrieved, July 25, 2019, from https://www.drugabuse.gov/news-events/nida-notes/2019/1/new-studies-clarify-risk-factors-neonatal-abstinence-syndrome
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Neonatal Abstinence Syndrome (NAS) Every 15 minutes, a baby is born
suffering from NAS.
Five times as many babies were born with NAS in 2009 as in 2000.
The average hospital stay in 2012 for infants exposed to substances was 16.9 days, compared to an average of 2.1 days for an infant not exposed to drugs.
Source: Center for Child Health Policy, Vanderbilt University Medical Center. (n.d.). [Web page showing NAS infographic]. Retrieved from https://www.vumc.org/childhealthpolicy/nasinfographicfullsize
Winkelman, T.N., Villapiano, N., Kozhimannil, K. B., Davis, M. M., & Patrick, S. W. (2018). Incidence and costs of neonatal abstinence syndrome among infants with Medicaid: 2004–2014. Pediatrics, 141(3), 1–8. Retrieved from https://pediatrics.aappublications.org/content/141/4/e20173520
Body shakes (tremors), seizures (convulsions), overactive reflexes (twitching), and tight muscle tone
Fussiness, excessive crying, or having a high-pitched cry Poor feeding or sucking or slow weight gain Breathing problems, including breathing really fast Fever, sweating or blotchy skin Trouble sleeping and lots of yawning Diarrhea or throwing up Stuffy nose or sneezing
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Symptoms of Neonatal Abstinence Syndrome (NAS)
Excerpted from March of Dimes. (2017). Neonatal abstinence syndrome [Web page]. Retrieved April 11, 2018, from https://www.marchofdimes.org/complications/neonatal-abstinence-syndrome-(nas).aspx
A toddler who has been exposed to opiates may experience one or more of the following symptoms:
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Possible Impact on Toddlers
Mental and motor deficits Cognitive delays Hyperactivity Impulsivity Attention deficit disorder Behavior disorders
Aggressiveness Less social responsivity or poor
social engagement Failure to thrive (socially) Short stature
Excerpted from U.S. Office of Special Education Programs. (n.d.). Intervention IDEAs for infants, toddlers, children, and youth impacted by opioids, p. 2, emphasis added [Issue brief]. Retrieved from https://osepideasthatwork.org/sites/default/files/IDEAslIssBrief-Opioids-508.pdf
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Short- and Long-Term Effects of Prenatal Exposure
Information Source: Behnke, M., Smith, V. C., Committee on Substance Abuse, & Committee on Fetus and Newborn. (2013). Prenatal substance abuse: Short- and long-term effects on the exposed fetus. Pediatrics, 131(3), 1009–24. Retrieved from http://pediatrics.aappublications.org/content/131/3/e1009.full
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Information Memorandum, June 5, 2019:Child Care and Development Fund (CCDF) Policy
Opportunities for Supporting Populations Impacted by Opioid Misuse and Substance Use Disorders
Available at https://www.acf.hhs.gov/occ/resource/ccdf-acf-im-2019-01
To assist CCDF Lead Agencies supporting the economic stability of families by enhancing access to child care and early learning services to support the development of vulnerable children, particularly in communities impacted by opioid misuse and substance use disorders.
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Purpose
Excerpted from Office of Child Care. (2019). Child Care and Development Fund (CCDF) policy opportunities for supporting populations impacted by opioid misuse and substance use disorders (CCDF-ACF-IM-2019-01). Retrieved from https://www.acf.hhs.gov/occ/resource/ccdf-acf-im-2019-01
Eligibility Coordination Consumer Education
Training Grants and Contracts
Quality Funds
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CCDF Policy Options
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Eligibility
Excerpted from Office of Child Care. (2019). Child Care and Development Fund (CCDF) policy opportunities for supporting populations impacted by opioid misuse and substance use disorders (CCDF-ACF-IM-2019-01). Retrieved from https://www.acf.hhs.gov/occ/resource/ccdf-acf-im-2019-01
If the Lead Agency wants to enhance CCDF eligibility options for families addressing opioid misuse or substance use disorder, some eligibility policy options to consider are:
Including Substance Use Treatment as an Eligible Activity Protective Services Eligibility
Important Considerations: State’s definition of child abuse and neglect as it relates to parental
substance use; and Mandatory reporting responsibilities of each individual in the child care
system (e.g. providers, directors, CCDF eligibility workers)
CCDF requires States to coordinate the provision of services with other agencies … OCC recommends that required collaboration include coordinated efforts for how agencies can address opioid misuse and substance use disorders.
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Coordination
Excerpted from Office of Child Care. (2019). Child Care and Development Fund (CCDF) policy opportunities for supporting populations impacted by opioid misuse and substance use disorders (CCDF-ACF-IM-2019-01). Retrieved from https://www.acf.hhs.gov/occ/resource/ccdf-acf-im-2019-01
CCDF requires comprehensive consumer education efforts, which can be used to provide families with vital information on misuse of opioids, alcohol and other substances. Consumer education could include dissemination of information about:
Other programs for which families that receive CCDF assistance may be eligible …
Evolving research and best practices
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Consumer Education
Excerpted from Office of Child Care. (2019). Child Care and Development Fund (CCDF) policy opportunities for supporting populations impacted by opioid misuse and substance use disorders (CCDF-ACF-IM-2019-01). Retrieved from https://www.acf.hhs.gov/occ/resource/ccdf-acf-im-2019-01
CCDF requires that all caregivers, teachers, and providers serving CCDF children receive training in essential health and safety topics, including “recognition and reporting of child abuse and neglect,” “child development,” and “any other subject area determined by the Lead Agency to be necessary to promote child development or to protect children’s health and safety.”
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Training
Excerpted from Office of Child Care. (2019). Child Care and Development Fund (CCDF) policy opportunities for supporting populations impacted by opioid misuse and substance use disorders (CCDF-ACF-IM-2019-01). Retrieved from https://www.acf.hhs.gov/occ/resource/ccdf-acf-im-2019-01
Lead Agencies should consider examining their training and professional development systems to incorporate training on substance use disorder and opioid misuse, recognition of use and referral processes to appropriate addiction services and counseling.
Neonatal Abstinence Syndrome: Lead Agencies should consider whether their Health and Safety trainings should include Neonatal Abstinence Syndrome (NAS), which is a condition that happens when an infant goes through withdrawal from substance exposure after birth.
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Training
Excerpted from Office of Child Care. (2019). Child Care and Development Fund (CCDF) policy opportunities for supporting populations impacted by opioid misuse and substance use disorders (CCDF-ACF-IM-2019-01). Retrieved from https://www.acf.hhs.gov/occ/resource/ccdf-acf-im-2019-01
While CCDF subsidies primarily come in the form of vouchers and certificates, Lead Agencies can also establish grants and contracts with local organizations to establish child care slots for eligible children (such as, direct partnership with a treatment facility).
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Grants and Contracts
Excerpted from Office of Child Care. (2019). Child Care and Development Fund (CCDF) policy opportunities for supporting populations impacted by opioid misuse and substance use disorders (CCDF-ACF-IM-2019-01). Retrieved from https://www.acf.hhs.gov/occ/resource/ccdf-acf-im-2019-01
States are required to expend a percentage of their funds on activities to improve the quality of child care (“quality dollars”). Activities that may assist families impacted by opioids and substance misuse that may also align with allowable quality activities, include (but are not limited to):
Training and outreach Positive behavior interventions and support models High-quality program standards Consumer education provisions
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Quality Funds
Excerpted from Office of Child Care. (2019). Child Care and Development Fund (CCDF) policy opportunities for supporting populations impacted by opioid misuse and substance use disorders (CCDF-ACF-IM-2019-01). Retrieved from https://www.acf.hhs.gov/occ/resource/ccdf-acf-im-2019-01
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State and Territory Lead Agencies: Policy to Practice
Connecting to CCDF Plans
Priority of Administration for Children and Families and U.S. Department of Health and Human Services
Subsidy policy examples
12-month eligibility for foster care
Increased caseloads for family care and grandparents
Partnerships with other agencies
Professional development
High quality child care for low-income children
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Public health departments
Temporary Assistance for Needy Families
Medicaid and state children’s health insurance programs
Child care resource and referral agencies
Child welfare
Substance Abuse and Mental Health Services Administration
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Lead Agency Supports
Office of Child Care. (2019). Child Care and Development Fund (CCDF) policy opportunities for supporting populations impacted by opioid misuse and substance use disorders (CCDF-ACF-IM-2019-01). Retrieved from https://www.acf.hhs.gov/occ/resource/ccdf-acf-im-2019-01
Foster Care
Data source: Children’s Bureau, Administration on Children, Youth and Families, Administration for Children and Families, U.S. Department of Health and Human Services. (2018). The AFCARS report. Retrieved from https://www.acf.hhs.gov/sites/default/files/cb/afcarsreport25.pdf
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0
2
4
6
8
10
12
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16
18
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< 1 1 2 3 4 5 6 7 8 9 10 11 12
Perc
enta
ge
Years of Age
Percentage of Children Entering Foster Care
Support for Families and Caregivers
What we know … Increase of opioid misuse has significantly impacted the
child welfare system. Infants are coming into protective custody at alarming
rates. Grandparents are becoming primary caregivers for a
second time. What we can do … Increase family engagement strategies. Connect with comprehensive services.
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Impact on Grandparents 2.6 million children are being raised in
grandfamilies or kinship care with no birth parents in the home (4 percent of all children).
32 percent (139,017) of children in foster care are being raised by relatives.
For every child in foster care living with a relative, there are 19 children being raised by grandparents or other family members outside of the foster care system.
Excerpted from Generations United. (2018). Raising the children of the opioid epidemic: Solutions and support for grandfamilies, p. 2. Retrieved from https://www.gu.org/app/uploads/2018/09/Grandfamilies-Report-SOGF-Updated.pdf
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Region V Perspective
FY 2016–2018 FY 2016: First Taskforce: Drug Exposed Children in Indian Country in
Region V Map out other federal programs’ needs and resources (since we
typically work with the same families) Find duplications and areas of collaboration and coordination
FY 2018: Second Taskforce: Region V Prevention Collaborative/Opioid Subcommittee Consultation form States and tribal summits Quarterly meetings Webinars NAS Taskforce (local data)
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Join your state opioid taskforce or workgroup. These groups help map out other programs’ needs and resources (since we
typically work with the same families) and find duplications and areas of collaboration and
coordination.
Engage with federal, state, local, and tribal agencies in comprehensive and coordinated responses to the public health crisis of prescription drug misuse and opioid addiction.
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Where to Start
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Table Conversations
Is your State considering or currently implementing any of the policy options outlined in the IM?
What is your state doing (even if the efforts are not in your agency)?
What are the CCDF program’s contributions (at the state or local level, or both)?
How do you support families and providers with substance misuse issues?
How are state staff supported to address this issue? What agencies are you partnering with in your state, and
what agencies could you partner with?
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Discussion Questions
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Next Steps
Child Care and Development Fund (CCDF) Policy Opportunities for Supporting Populations Impacted by Opioid Misuse and Substance Use Disorders[Information memorandum], Office of Child Care (2019),https://www.acf.hhs.gov/occ/resource/ccdf-acf-im-2019-01
Drug overdose deaths in the United States [Community assessment tool], NORC (n.d.), https://opioidmisusetool.norc.org/
Neonatal Abstinence Syndrome [Web page], National Center on Substance Abuse and Child Welfare (n.d.), https://ncsacw.samhsa.gov/resources/opioid-use-disorders-and-medication-assisted-treatment/neonatal-abstinence-syndrome.aspx
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Resources
Opioid Overdose Prevention Toolkit, Substance Abuse and Mental Health Services Administration (revised 2018), https://store.samhsa.gov/product/Opioid-Overdose-Prevention-Toolkit/SMA18-4742
Opioid summaries by state [Web page], National Institute on Drug Abuse (revised 2019), https://www.drugabuse.gov/drugs-abuse/opioids/opioid-summaries-by-state
Substance Misuse [Web page], Head Start Early Childhood Learning and Knowledge Center (updated 2019), https://eclkc.ohs.acf.hhs.gov/mental-health/article/substance-misuse
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Resources
Thank You
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